ACHS118A ;IHS/OIT/FCJ - ACHS 3.1 PATCH 18 2 of 2 ;7/30/10 08:48
;;3.1;CONTRACT HEALTH MGMT SYSTEM;**18**;JUNE 11,2001
;ACHS*3.1*18 New routine
;;ACHS*3.1*18; IHS/OIT/ABK Added new tags SETBLR and LTSETS
;
;
P16OPT ;EP - FR KIDS
;ADD NEW OPTIONS - P16, DENIAL REPORT, 2-SSC REPORTS
D BMES^XPDUTL("Begin adding new options.")
I $$ADD^XPDMENU("ACHS DEFDEN MENU DEN REPORTS","ACHS DEN REP-CARE NOT MED PRI","CARE") D MES^XPDUTL($J("",5)_"Added to Denial Reports - Care not within Medical Priority")
I $$ADD^XPDMENU("ACHS MENU SCC REPORTS","ACHSRPTOBJPAY","PAY") D MES^XPDUTL($J("",5)_"Added to SSC Reports - Payment Report by Object Classification")
I $$ADD^XPDMENU("ACHS MENU SCC REPORTS","ACHSRPTOBJPAYSUM","SUM") D MES^XPDUTL($J("",5)_"Added to SSC Reports - Payment Summary Report by Object Classification")
D MES^XPDUTL("END updating options.")
Q
P18OPT ;EP - FR KIDS
;ADD NEW OPTIONS - P18, Denial GAO file, GPRA REPORT
D BMES^XPDUTL("Begin adding new options.")
I $$ADD^XPDMENU("ACHS DEFDEN MENU","ACHS DEFDEN GAO","GAO",7) D MES^XPDUTL($J("",5)_"Added to Denial-Umet Need Menu - Create File for GAO")
I $$ADD^XPDMENU("ACHSREPORTS","ACHSRPT GPRA","GPRA") D MES^XPDUTL($J("",5)_"Added to Reports - GPRA Report for DOS vs Issue date")
I $$ADD^XPDMENU("ACHSMGR","ACHS CHSDA","SDA",7) D MES^XPDUTL($J("",5)_"Added to Facility Management Menu - Enter/Edit Tribal CHSDA")
I $$ADD^XPDMENU("ACHSREPORTS","ACHSRPT ELG","ELG") D MES^XPDUTL($J("",5)_"Added to Reports - CHS Eligible patients by CHSDA")
;
;{ABK,6/30/10} Additional options
I $$ADD^XPDMENU("ACHS DEFDEN MENU","ACHS DEFDEN MENU DENIAL","DEN",2) D MES^XPDUTL($J("",5)_"Added to ACHS Denial/Unmet Needs - Denial Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU","ACHS DEFDEN MENU UNMET NEED","UMN",3) D MES^XPDUTL($J("",5)_"Added to ACHS Denial/Unmet Needs - Unmet Need Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU","ACHS DEFDEN MENU PARM","PAR",1) D MES^XPDUTL($J("",5)_"Added to ACHS Denial/Unmet Needs - Unmet Need Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU PARM","ACHS DEFDEN MENU LFP","LFP") D MES^XPDUTL($J("",5)_"Added to Denial Parameters - Letter Format Parameters")
I $$ADD^XPDMENU("ACHS DEFDEN MENU PARM","ACHS DEFDEN MENU BENC","BC") D MES^XPDUTL($J("",5)_"Added to Denial Parameters - Benefit Coordinator Parameters")
I $$ADD^XPDMENU("ACHS DEFDEN MENU PARM","ACHS DEN ALT RES TYPE","ALTY") D MES^XPDUTL($J("",5)_"Added to Denial Parameters - Alternate Resource Type")
I $$ADD^XPDMENU("ACHS DEFDEN MENU LFP","ACHS DEFDEN MENU PARM OFF","LM") D MES^XPDUTL($J("",5)_"Added to Letter Format Parameters - Set Left Margin")
I $$ADD^XPDMENU("ACHS DEFDEN MENU LFP","ACHS DEFDEN MENU PARM L15","TM") D MES^XPDUTL($J("",5)_"Added to Letter Format Parameters - Set Top Margin")
I $$ADD^XPDMENU("ACHS DEFDEN MENU BENC","ACHS DEFDEN MENU BCN","NM") D MES^XPDUTL($J("",5)_"Added to Benefit Coordinator Parameters - Set Benefit Coordinator Name")
I $$ADD^XPDMENU("ACHS DEFDEN MENU BENC","ACHS DEFDEN MENU BCP","PH") D MES^XPDUTL($J("",5)_"Added to Benefit Coordinator Parameters - Set Benefit Coordinator Phone")
I $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEFDEN MENU DEN REPORTS","REP") D MES^XPDUTL($J("",5)_"Add Denial Reports option to Denial Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEN ADD","ADD") D MES^XPDUTL($J("",5)_"Add option to Add a Denial to the Denial Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEFDEN MENU DEN LTRS","DENL") D MES^XPDUTL($J("",5)_"Add Denial Letter Menu to Denial Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEN CANCEL","CAN") D MES^XPDUTL($J("",5)_"Add Cancel option to Denial Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEFDEN MENU DEN SUPP","SUP") D MES^XPDUTL($J("",5)_"Add Denial Supplement option to ACHS Denial Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEN APPEAL MENU","APP") D MES^XPDUTL($J("",5)_"Added Appeal option to Denial Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEF ADD","ADD") D MES^XPDUTL($J("",5)_"Added Add Unmet need option to Unmet Need Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEF CANCEL","CAN") D MES^XPDUTL($J("",5)_"Added Cancel option to Unmet Need Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEF LETTER","PRT") D MES^XPDUTL($J("",5)_"Added Print Letter option to Unmet Need Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEFDEN MENU DEF SUPP","SUP") D MES^XPDUTL($J("",5)_"Added Supplemental option to Unmet Need Menu")
I $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEFDEN MENU DEF RPT","REP") D MES^XPDUTL($J("",5)_"Added Report option to Unmet Need Menu")
D MES^XPDUTL("END updating options.")
;
SDA ;
D ADD^ACHSSDA
D MES^XPDUTL("Completed updating CHS Service Delivery file, for items that could not be added see ACHSTMP global")
;
SETBLR ;ACHS*3.1*18 IHS/OIT/ABK Set CHS Denial Facility Parms for denial Letter Boilerplate
N ACHSDA
;
;DENIAL LETTER BOILERPLATE
S MTEXT="We have been requested to authorize payment for medical services received from the above provider(s). Please understand that after careful"
S MTEXT2=" review of the Contract Health Service rules and regulations, we must advise you the ACHSFAC will not authorize payment for the following reason(s):"
S BTEXT="RECONSIDERATION AND APPEAL [Per 42 CFR 136.25]. You may appeal the denial in writing. Please submit a statement supporting the reason for the appeal. NOTE: "
S BTEXT1="If you fail to submit a written appeal within (30) days of receipt of this letter, payment will be denied through the CHS program. "
S BTEXT2="If you have additional information that may affect our decision, please submit it in writing within 30 days of receipt of this letter to: "
S CTEXT="If you do not have additional information, you may appeal in writing, within 30 days of receipt of this letter:"
;
;SET Letter Text
S ACHSDA=0 F S ACHSDA=$O(^ACHSDENR(ACHSDA)) Q:ACHSDA'?1N.N D LTSETS
D DENUP
Q
;
LTSETS ; Set lettter boilerplate into facilities - quit if 638 facility
;New variables and If unit not defined properly, quit
N ACHSX,ACHSFAC,FTIDX,EMSG
S ACHSX=$G(^ACHSF(ACHSDA,0))=""
Q:ACHSX=""
;If Tribal quit
Q:$P(ACHSX,U,8)="Y"
;
;{ABK, 6/25/10}Add logic to print facility name in middle text
S ACHSFAC=$P(^DIC(4,ACHSDA,0),U,1)
;
;
S DIE="^ACHSDENR(",DA=ACHSDA
S DR="2///"_MTEXT_MTEXT2
S EMSG="CHS Denial Facility Parameters for Facility "_ACHSFAC_" Denial Letter Middle Text"
D ^DIE
D BMES^XPDUTL("Updated - "_EMSG)
;
S DR="3///"_BTEXT_BTEXT1_BTEXT2
S EMSG="CHS Denial Facility Parameters for Facility "_ACHSFAC_" Denial Letter Bottom Text"
D ^DIE
D BMES^XPDUTL("Updated - "_EMSG)
;
S DR="8///"_CTEXT
S EMSG="CHS Denial Facility Parameters for Facility "_ACHSFAC_" Denial Letter Closing Text"
D ^DIE
D BMES^XPDUTL("Updated - "_EMSG)
D ^XBFMK
Q
;
DENUP ;DENIAL REASON UPDATE FOR ALT REC
NEW ACHSDA
S X="Alternate Resource Available"
S DA=0
S DA=$O(^ACHSDENS("B",X,DA)) Q:DA'?1N.N
S DIE="^ACHSDENS("
S DA=DA,DR="1///"_""
D ^DIE
D ^XBFMK
Q
ERRM ;Handle insert error messages
;
D BMES^XPDUTL("Unable to update - "_EMSG)
D BMES^XPDUTL("You will need to manually update this text thru fileman")
D BMES^XPDUTL(X)
Q
ACHS118A ;IHS/OIT/FCJ - ACHS 3.1 PATCH 18 2 of 2 ;7/30/10 08:48
+1 ;;3.1;CONTRACT HEALTH MGMT SYSTEM;**18**;JUNE 11,2001
+2 ;ACHS*3.1*18 New routine
+3 ;;ACHS*3.1*18; IHS/OIT/ABK Added new tags SETBLR and LTSETS
+4 ;
+5 ;
P16OPT ;EP - FR KIDS
+1 ;ADD NEW OPTIONS - P16, DENIAL REPORT, 2-SSC REPORTS
+2 DO BMES^XPDUTL("Begin adding new options.")
+3 IF $$ADD^XPDMENU("ACHS DEFDEN MENU DEN REPORTS","ACHS DEN REP-CARE NOT MED PRI","CARE")
DO MES^XPDUTL($JUSTIFY("",5)_"Added to Denial Reports - Care not within Medical Priority")
+4 IF $$ADD^XPDMENU("ACHS MENU SCC REPORTS","ACHSRPTOBJPAY","PAY")
DO MES^XPDUTL($JUSTIFY("",5)_"Added to SSC Reports - Payment Report by Object Classification")
+5 IF $$ADD^XPDMENU("ACHS MENU SCC REPORTS","ACHSRPTOBJPAYSUM","SUM")
DO MES^XPDUTL($JUSTIFY("",5)_"Added to SSC Reports - Payment Summary Report by Object Classification")
+6 DO MES^XPDUTL("END updating options.")
+7 QUIT
P18OPT ;EP - FR KIDS
+1 ;ADD NEW OPTIONS - P18, Denial GAO file, GPRA REPORT
+2 DO BMES^XPDUTL("Begin adding new options.")
+3 IF $$ADD^XPDMENU("ACHS DEFDEN MENU","ACHS DEFDEN GAO","GAO",7)
DO MES^XPDUTL($JUSTIFY("",5)_"Added to Denial-Umet Need Menu - Create File for GAO")
+4 IF $$ADD^XPDMENU("ACHSREPORTS","ACHSRPT GPRA","GPRA")
DO MES^XPDUTL($JUSTIFY("",5)_"Added to Reports - GPRA Report for DOS vs Issue date")
+5 IF $$ADD^XPDMENU("ACHSMGR","ACHS CHSDA","SDA",7)
DO MES^XPDUTL($JUSTIFY("",5)_"Added to Facility Management Menu - Enter/Edit Tribal CHSDA")
+6 IF $$ADD^XPDMENU("ACHSREPORTS","ACHSRPT ELG","ELG")
DO MES^XPDUTL($JUSTIFY("",5)_"Added to Reports - CHS Eligible patients by CHSDA")
+7 ;
+8 ;{ABK,6/30/10} Additional options
+9 IF $$ADD^XPDMENU("ACHS DEFDEN MENU","ACHS DEFDEN MENU DENIAL","DEN",2)
DO MES^XPDUTL($JUSTIFY("",5)_"Added to ACHS Denial/Unmet Needs - Denial Menu")
+10 IF $$ADD^XPDMENU("ACHS DEFDEN MENU","ACHS DEFDEN MENU UNMET NEED","UMN",3)
DO MES^XPDUTL($JUSTIFY("",5)_"Added to ACHS Denial/Unmet Needs - Unmet Need Menu")
+11 IF $$ADD^XPDMENU("ACHS DEFDEN MENU","ACHS DEFDEN MENU PARM","PAR",1)
DO MES^XPDUTL($JUSTIFY("",5)_"Added to ACHS Denial/Unmet Needs - Unmet Need Menu")
+12 IF $$ADD^XPDMENU("ACHS DEFDEN MENU PARM","ACHS DEFDEN MENU LFP","LFP")
DO MES^XPDUTL($JUSTIFY("",5)_"Added to Denial Parameters - Letter Format Parameters")
+13 IF $$ADD^XPDMENU("ACHS DEFDEN MENU PARM","ACHS DEFDEN MENU BENC","BC")
DO MES^XPDUTL($JUSTIFY("",5)_"Added to Denial Parameters - Benefit Coordinator Parameters")
+14 IF $$ADD^XPDMENU("ACHS DEFDEN MENU PARM","ACHS DEN ALT RES TYPE","ALTY")
DO MES^XPDUTL($JUSTIFY("",5)_"Added to Denial Parameters - Alternate Resource Type")
+15 IF $$ADD^XPDMENU("ACHS DEFDEN MENU LFP","ACHS DEFDEN MENU PARM OFF","LM")
DO MES^XPDUTL($JUSTIFY("",5)_"Added to Letter Format Parameters - Set Left Margin")
+16 IF $$ADD^XPDMENU("ACHS DEFDEN MENU LFP","ACHS DEFDEN MENU PARM L15","TM")
DO MES^XPDUTL($JUSTIFY("",5)_"Added to Letter Format Parameters - Set Top Margin")
+17 IF $$ADD^XPDMENU("ACHS DEFDEN MENU BENC","ACHS DEFDEN MENU BCN","NM")
DO MES^XPDUTL($JUSTIFY("",5)_"Added to Benefit Coordinator Parameters - Set Benefit Coordinator Name")
+18 IF $$ADD^XPDMENU("ACHS DEFDEN MENU BENC","ACHS DEFDEN MENU BCP","PH")
DO MES^XPDUTL($JUSTIFY("",5)_"Added to Benefit Coordinator Parameters - Set Benefit Coordinator Phone")
+19 IF $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEFDEN MENU DEN REPORTS","REP")
DO MES^XPDUTL($JUSTIFY("",5)_"Add Denial Reports option to Denial Menu")
+20 IF $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEN ADD","ADD")
DO MES^XPDUTL($JUSTIFY("",5)_"Add option to Add a Denial to the Denial Menu")
+21 IF $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEFDEN MENU DEN LTRS","DENL")
DO MES^XPDUTL($JUSTIFY("",5)_"Add Denial Letter Menu to Denial Menu")
+22 IF $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEN CANCEL","CAN")
DO MES^XPDUTL($JUSTIFY("",5)_"Add Cancel option to Denial Menu")
+23 IF $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEFDEN MENU DEN SUPP","SUP")
DO MES^XPDUTL($JUSTIFY("",5)_"Add Denial Supplement option to ACHS Denial Menu")
+24 IF $$ADD^XPDMENU("ACHS DEFDEN MENU DENIAL","ACHS DEN APPEAL MENU","APP")
DO MES^XPDUTL($JUSTIFY("",5)_"Added Appeal option to Denial Menu")
+25 IF $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEF ADD","ADD")
DO MES^XPDUTL($JUSTIFY("",5)_"Added Add Unmet need option to Unmet Need Menu")
+26 IF $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEF CANCEL","CAN")
DO MES^XPDUTL($JUSTIFY("",5)_"Added Cancel option to Unmet Need Menu")
+27 IF $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEF LETTER","PRT")
DO MES^XPDUTL($JUSTIFY("",5)_"Added Print Letter option to Unmet Need Menu")
+28 IF $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEFDEN MENU DEF SUPP","SUP")
DO MES^XPDUTL($JUSTIFY("",5)_"Added Supplemental option to Unmet Need Menu")
+29 IF $$ADD^XPDMENU("ACHS DEFDEN MENU UNMET NEED","ACHS DEFDEN MENU DEF RPT","REP")
DO MES^XPDUTL($JUSTIFY("",5)_"Added Report option to Unmet Need Menu")
+30 DO MES^XPDUTL("END updating options.")
+31 ;
SDA ;
+1 DO ADD^ACHSSDA
+2 DO MES^XPDUTL("Completed updating CHS Service Delivery file, for items that could not be added see ACHSTMP global")
+3 ;
SETBLR ;ACHS*3.1*18 IHS/OIT/ABK Set CHS Denial Facility Parms for denial Letter Boilerplate
+1 NEW ACHSDA
+2 ;
+3 ;DENIAL LETTER BOILERPLATE
+4 SET MTEXT="We have been requested to authorize payment for medical services received from the above provider(s). Please understand that after careful"
+5 SET MTEXT2=" review of the Contract Health Service rules and regulations, we must advise you the ACHSFAC will not authorize payment for the following reason(s):"
+6 SET BTEXT="RECONSIDERATION AND APPEAL [Per 42 CFR 136.25]. You may appeal the denial in writing. Please submit a statement supporting the reason for the appeal. NOTE: "
+7 SET BTEXT1="If you fail to submit a written appeal within (30) days of receipt of this letter, payment will be denied through the CHS program. "
+8 SET BTEXT2="If you have additional information that may affect our decision, please submit it in writing within 30 days of receipt of this letter to: "
+9 SET CTEXT="If you do not have additional information, you may appeal in writing, within 30 days of receipt of this letter:"
+10 ;
+11 ;SET Letter Text
+12 SET ACHSDA=0
FOR
SET ACHSDA=$ORDER(^ACHSDENR(ACHSDA))
IF ACHSDA'?1N.N
QUIT
DO LTSETS
+13 DO DENUP
+14 QUIT
+15 ;
LTSETS ; Set lettter boilerplate into facilities - quit if 638 facility
+1 ;New variables and If unit not defined properly, quit
+2 NEW ACHSX,ACHSFAC,FTIDX,EMSG
+3 SET ACHSX=$GET(^ACHSF(ACHSDA,0))=""
+4 IF ACHSX=""
QUIT
+5 ;If Tribal quit
+6 IF $PIECE(ACHSX,U,8)="Y"
QUIT
+7 ;
+8 ;{ABK, 6/25/10}Add logic to print facility name in middle text
+9 SET ACHSFAC=$PIECE(^DIC(4,ACHSDA,0),U,1)
+10 ;
+11 ;
+12 SET DIE="^ACHSDENR("
SET DA=ACHSDA
+13 SET DR="2///"_MTEXT_MTEXT2
+14 SET EMSG="CHS Denial Facility Parameters for Facility "_ACHSFAC_" Denial Letter Middle Text"
+15 DO ^DIE
+16 DO BMES^XPDUTL("Updated - "_EMSG)
+17 ;
+18 SET DR="3///"_BTEXT_BTEXT1_BTEXT2
+19 SET EMSG="CHS Denial Facility Parameters for Facility "_ACHSFAC_" Denial Letter Bottom Text"
+20 DO ^DIE
+21 DO BMES^XPDUTL("Updated - "_EMSG)
+22 ;
+23 SET DR="8///"_CTEXT
+24 SET EMSG="CHS Denial Facility Parameters for Facility "_ACHSFAC_" Denial Letter Closing Text"
+25 DO ^DIE
+26 DO BMES^XPDUTL("Updated - "_EMSG)
+27 DO ^XBFMK
+28 QUIT
+29 ;
DENUP ;DENIAL REASON UPDATE FOR ALT REC
+1 NEW ACHSDA
+2 SET X="Alternate Resource Available"
+3 SET DA=0
+4 SET DA=$ORDER(^ACHSDENS("B",X,DA))
IF DA'?1N.N
QUIT
+5 SET DIE="^ACHSDENS("
+6 SET DA=DA
SET DR="1///"_""
+7 DO ^DIE
+8 DO ^XBFMK
+9 QUIT
ERRM ;Handle insert error messages
+1 ;
+2 DO BMES^XPDUTL("Unable to update - "_EMSG)
+3 DO BMES^XPDUTL("You will need to manually update this text thru fileman")
+4 DO BMES^XPDUTL(X)
+5 QUIT
